Multiple brown tumors causing spinal cord compression in association with secondary hyperparathyroidism

Abstract

Brown tumor, a non-neoplastic process resulting from excess osteoclast activity, is found in primary hyperparathyroidism (HPTP) and secondary hyperparathyroidism (HPTS). We report a rare case of multiple spinal cord compression by brown tumors. A 47-year-old male with end-stage renal disease caused by hypertensive nephrosclerosis, on hemodialysis for 10 years and diagnosed with severe HPTS, developed back pain and sudden onset of gait difficulties progressing to paraplegia. A previous computed tomography (CT) of the lumbosacral spine demonstrated a solid lesion, located in the body of the sacrum, at S1-S2 level, with fine bone edge sclerosis, suggestive of brown tumor. A magnetic resonance imaging without gadolinium injection was performed. The examination revealed an insufflating bone lesion at thoracic level (T5/T6). Posterior laminectomy was followed by tumor excision. Histopathological analysis showed osteoid tissue streaked by fibroplasia with hemosiderin granulation. Differential diagnosis of sudden neurologic deficits and paraplegia in renal patients with secondary HPPT must consider the possibility of brown tumor.